Arriving for her annual exam at Treichville Teaching Hospital (CHUT) in Abidjan, Mariam Cissé was about to receive news that would turn her world upside down. A year earlier, Mariam, an HIV-positive mother of three children, had been screened for cervical cancer using a technique called visual inspection with ascetic acid (VIA). The doctor had found no abnormalities, and Mariam returned to her home near Abidjan where she works as a merchant.

When Mariam visited CHUT for her routine visit a year later, she was shocked to hear that a large lesion had formed on her cervix – too large to be treated with cryotherapy. After a pap smear confirmed a malignant abnormality on her cervix, Mariam was advised to consider a radical hysterectomy – a $1,400 procedure. Because Mariam spent all her earnings from one day to the next, paying for this procedure was out of the question.

Devastated, Mariam was at a loss for how to respond. Her anguish continued to grow until she received a call from a midwife at CHUT. The midwife explained that there was an outpatient treatment for cervical lesions that were too large for cryotherapy, called loop electrical excision procedure (LEEP). It was available and more importantly, it was free.

In 2009, the National HIV/AIDS Care and Treatment Program in partnership with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention, introduced cervical cancer prevention with VIA and treatment with cryotherapy for HIV-positive women in Côte d’Ivoire. Through the work of PEPFAR implementing partner Jhpiego, 20 sites in major cities throughout the country now offer cervical cancer screening and treatment services by 98 trained providers. In March 2012, two referral sites in Abidjan and Bouake were upgraded and began offering LEEP for treatment of large lesions.

To date, 7,343 HIV-positive women have been screened with VIA. As a result, 365 of these women with small lesions were treated with cryotherapy and an additional 64 women with larger precancerous lesions benefited from LEEP.

Armed with this new information about options available to her, Mariam underwent the LEEP procedure at the CHUT on March 29, 2012. Asked how she feels, Mariam smiles as she begins to cry.